The Skinny on Stretch Marks

It isn’t a stretch (pun intended) to say no one wants stretch marks on any part of their body. Once these grooved, tread-like marks show up, the quest to find something, anything to get rid of them begins. As you might imagine, I receive an amazing number of emails asking me which products or medical procedures really get rid of stretch marks. I’m sure the volume of these questions is in direct response to the assortment of advertisements promising to smooth out these strange bodily striations. In the world of cosmetics, a consumer’s burning desire to have flawless skin always leads to hype and myths about what products can and can’t work. And bogus products for stretch marks abound.

Products that lead women to waste their money and hope for an improvement in the appearance of stretch marks include StriVectin-SD, Mederma, Vita-K Solution, Magia Bella, Maternity Solutions, ScarSof Scar Softening Cream, Phytomer, Decleor, Mustela, and Caudalie. Despite the ads you’ve seen and the claims you’ve heard about these products, none of them have substantiated evidence they can make a positive impact on the formation or prevention of stretch marks, but of course, that never stops the cosmetics industry from trying to convince you otherwise.

Medically speaking, stretch marks are called striae distensae. While we know a lot about stretch marks, there is still a great deal not yet fully understood about their cause and restoration (Source: www.emedicine.com/derm/topic406.htm). Here’s what is known:

Stretch marks occur when skin is abnormally distended or stretched for a period of time, such as from pregnancy or weight gain, causing the skin’s support structure (in the form of collagen and elastin) to break down or rupture. In fact, the visibly curled ends of stretch marks are actually bands of elastin broken beneath the skin. Essentially, stretch marks are a scar that has formed from the inside out, rather than scarring that occurs when skin is externally wounded. There appears to be a genetic tendency toward them, but the exact link is not clear. It is speculated that the way each person’s skin heals is a good indicator of the depth and severity of stretch marks they may eventually see. A person whose skin heals well with minimal scarring can expect less obvious stretch marks, while skin that heals poorly (or slowly) or tends to develop raised or thickened scars can generally expect stretch marks that are more pronounced.

It may surprise you to know that in the United States it is estimated that 90% of pregnant women, 70% of adolescent females and 40% of adolescent males have stretch marks. There does not seem to be an ethnic tendency toward stretch marks, as all races can be affected. Individuals with fair to light skin typically have pink-tinged stretch marks while the same marks on darker skin tones tend to take on a deeper pigmentation than the skin surrounding them. Discoloration from these marks does fade over time, but regrettably, the striated appearance rarely returns to its original smooth appearance.

Is there anything you can do to improve or eliminate the appearance of stretch marks? First of all, you need to know that, despite numerous cosmetic products (StriVectin-SD being the most heavily advertised) making claims of being able to fade, prevent, or eliminate stretch marks, that just isn’t possible. There are no cosmetic ingredients that can change the structure of skin in a way that would raise the indentations back to where the skin level used to be. However, there is research showing tretinoin (the active ingredient in Retin-A, Renova, Tazorac, or in generic form) can have a positive effect. Because tretinoin can stimulate elastin synthesis, remodel collagen in the dermis, and improve skin’s texture and color, it can be a strong (though not curative) ally for improving the appearance of stretch marks. A 0.05% or 0.1% concentration of tretinoin is recommended, and the best results are seen when this drug is used at the first signs of stretch marks. Typical improvement is 20%, which isn’t necessarily exciting, but may still be worth the effort and expense (Sources: Advances in Therapy, July/August 2001, Volume 18, Issue 4, pages 181–186; and Dermatology Nursing, Volume 16, Issue 6, December 2004). The dilemma for expectant mothers is that tretinoin cannot be used during pregnancy, and is also contraindicated if the mother-to-be intends to breastfeed her baby.

Other than topically applying tretinoin there are other medical cosmetic corrective procedures that can have very good results. These methods include chemical peels and non-ablative laser treatments. Studies have been conducted using Intense Pulsed Light (IPL) and Pulsed Dye Laser (PDL) treatments emitting 585 nanometers (nm) of light. Results after five sessions were labeled as a clinical improvement, with microscopic analysis showing improvement in the length, depth, and coloration of stretch marks. This type of laser carries a low risk of side effects and complications when operated at appropriate treatment parameters and time intervals. (Sources: Dermatologic Surgery, December 2002, page 1124; Dermatologic Clinics, January 2002, pages 55–65) but they are not recommended for use on darker skin tones (including African-American) because of the risk of hyperpigmentation (Source: Dermatologic Surgery, May 1999, page 368). Cost for a series of treatments can run upwards of $2,500 depending on how your skin responds and what the average fees are in your area.

Beyond non-ablative lasers, you can also consider a series of chemical peels. Trichloroacetic acid (TCA) peels may be of some help for improving the appearance of stretch marks when used at the proper concentration (typically 20% TCA) and applied by a dermatologist or cosmetic surgeon skilled in the use of this type of peel. A benefit of TCA peels (and the reason it can help improve the appearance of stretch marks) is their skin-tightening effect. Because TCA peels penetrate further than AHA or BHA peels, they are believed to have a greater ability to stimulate collagen and elastin for the depth of damage seen in stretch marks. As you may recall, deep damaged strands of these skin-supporting substances are chiefly responsible for the emergence of stretch marks.

One more myth to bust: you may have heard that specific moisturizing ingredients such as cocoa butter, vitamin E, or other various plant oils can prevent or reduce the appearance of stretch marks. As soothing and moisturizing as these ingredients are, they have no impact on how stretch marks are formed. Stretch marks are not caused because skin is dry or needs a special supplement. Rather stretch marks develop far below the skin’s surface due to extreme strain, stress, and trauma that eventually breaks down the skin’s support structure. No moisturizer in the world can prevent that kind of injury and damage to the skin from taking place.

Additional sources for this article: www.emedicine.com; Your Best Face: Looking Your Best Without Cosmetic Surgery by Brandith Irwin, M.D., Hay House, 2002, page 124; and Dermatologic Surgery, October 1999, page 773).

Paula Begoun